Cardiogenic shock associated with loco-regional anesthesia rescued with left ventricular assist device implantation

Abstract

A healthy 53 year old man developed profound cardiogenic shock following instillation of bupivacaine-lidocaine-epinephrine solution as a locoregional anesthetic for elective outpatient shoulder surgery. Intubation, resuscitation, and transfer to the nearby hospital were done: echocardiography showed profound biventricular dysfunction; cardiac catheterization showed normal coronary arteries. Despite placement of an intra-aortic balloon pump and intravenous vasoactive drugs, the patient remained in shock. Stabilization was achieved with emergent institution of cardiopulmonary bypass and placement of a temporary left ventricular assist device (LVAD). Twenty-four hours later, cardiac function normalized and the LVAD was removed. The patient was discharged five days later and remained with normal heart function in three-year follow-up.

Cardiac Assist Devices: Early Concepts, Current Technologies, and Future Innovations

“…ECMO ( A ), AbioMed Impella ( B ), Teleflex Arrow IABP ( C ), and Thoratec CentriMag ( D ) are examples of temporary support mechanisms commonly used in clinical settings today [64,65,66,67]. …”